Effect of intravitreal anti-VEGF on choroidal thickness in patients with diabetic macular edema using spectral domain OCT

ABSTRACT Purpose: To evaluate choroidal thickness (CT) using spectral domain optical coherence tomography (SD-OCT) imaging at baseline and 6 months after intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment in patients with diabetic macular edema (DME). Methods: A retrospective chart review was performed to identify patients with DME who underwent intravitreal injection of anti-VEGF (bevacizumab or ranibizumab) in a pro re nata (PRN) regimen. Subfoveal choroidal thickness was compared between values obtained at baseline and at 6-month follow-up visits. Results: Thirty-nine eyes (15 females, 24 males) from 39 patients were enrolled (mean age, 62.43 ± 8.7 years; range, 44-79 years). Twenty-three and 16 eyes were treated with ranibizumab and bevacizumab respectively. The mean number of anti-VEGF injections was 2.28 ± 1.27 (range, 1-5). Mean nasal, subfoveal, and temporal choroidal thickness (CT) measurements at baseline were 234.10 ± 8.63 µm, 246.89 ± 8.94 µm, and 238.12 ± 8.20 µm, respectively, and those at 6 months post-treatment were 210.46 ± 8.00 µm, 215.66 ± 8.29 µm, and 212.43 ± 8.14 µm, respectively. Significant differences in CT were observed between baseline and the 6-month follow-up at all measured points (p=0.0327). Conclusions: Over a 6-month period, the use of intravitreal anti-VEGF was associated with significant thinning of the choroid in patients with DME. The clinical significance of a thinner choroid in DME is currently unknown; however, it may contribute to long-term adverse effects on choroidal and retinal function, representing an area requiring future investigation.

摘要 目的：采用谱域光学相干断层扫描（SD-OCT）成像，评估糖尿病性黄斑水肿（DME）患者基线状态及玻璃体内抗血管内皮生长因子（anti-vascular endothelial growth factor, anti-VEGF）治疗6个月后的脉络膜厚度（CT）。方法：本研究采用回顾性病历分析方法，筛选接受按需治疗（PRN）方案、行玻璃体内注射anti-VEGF（贝伐珠单抗或雷珠单抗）的DME患者，对比基线与6个月随访时的黄斑中心凹下脉络膜厚度。结果：共纳入39例患者的39只患眼（其中女性15例，男性24例），平均年龄62.43±8.7岁，年龄范围44~79岁。23只患眼接受雷珠单抗治疗，16只患眼接受贝伐珠单抗治疗。anti-VEGF注射平均次数为2.28±1.27次，范围1~5次。基线时鼻侧、黄斑中心凹下及颞侧脉络膜厚度均值分别为234.10±8.63 μm、246.89±8.94 μm及238.12±8.20 μm；治疗6个月后对应数值分别为210.46±8.00 μm、215.66±8.29 μm及212.43±8.14 μm。所有测量位点的脉络膜厚度在基线与6个月随访时均存在显著差异（p=0.0327）。结论：在6个月随访周期内，玻璃体内anti-VEGF治疗与DME患者的脉络膜显著变薄相关。目前DME患者脉络膜变薄的临床意义尚不明确，但该变化可能对脉络膜及视网膜功能产生长期不良影响，这一研究方向有待未来进一步探索。